Is endoscopy useful for early diagnosis of ischaemic colitis after aortic surgery? Results of a prospective trial.
BACKGROUND
Ischaemic colitis is an infrequent, but potentially fatal, complication of abdominal aortic surgery. Its presentation is often underestimated on account of a paucity of symptoms, thus the real incidence of ischaemic colitis may be higher.


OBJECTIVE
To determine the prognostic value and sensitivity of endoscopy, early postoperative endoscopic findings were evaluated.


METHODS
Over a period of three years a prospective study was undertaken in a consecutive series of 105 patients (mean age 68.9 years, range 51-85) undergoing routine rectosigmoidoscopy within 72 hours of aortic reconstructive surgery.


RESULTS
Colonic ischaemia was found in 12 patients (11.4%); five had endoscopic evidence of mild ischaemic colitis, ulcerations were identified in five and diffuse superficial necrosis in two. Seven of the 12 patients were symptomatic. Laparotomy was never deemed necessary and all patients were successfully treated with a conservative regimen. There were no deaths. Elective reconstruction or urgent procedure did not correlate with the development of colonic ischaemia, nor did duration of aortic cross-clamp time, patency of the inferior mesenteric artery and its possible ligation or reimplantation or patency of the hypogastric arteries.


CONCLUSIONS
Rectosigmoidoscopy is effective for early diagnosis of ischaemic colitis. Early endoscopy should be routinely performed only for patients in whom impaired blood flow is suspected on the basis of the intraoperative objective assessment of the colon and in presence of symptoms.
Fanti
L
L
Gastrointestinal Unit, San Raffaele Hospital, University of Milan, Italy.
Masci
E
E
Mariani
A
A
Chiesa
R
R
Jannello
A
A
Melissano
G
G
Castellano
R
R
Guerini
S
S
Tittobello
A
A
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017091:Colitis, Ischemic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy; D014656:Vascular Surgical Procedures / Q000009:adverse effects*